不同神经重建手术对大鼠臂丛根性损伤后伸腕伸指功能疗效的比较研究  

The comparative study of different nerve reconstruction for curing the brachial plexus root injury with wrist and finger drop

作　　者：聂铭博[1] 陈亮[1] 

机构地区：[1]复旦大学附属华山医院手外科,上海200040

出　　处：《中华显微外科杂志》2012年第2期114-118,共5页Chinese Journal of Microsurgery

基　　金：国家自然科学基金项目（30973055）

摘　　要：目的比较不同神经重建手术对幼、成年大鼠臂丛根性损伤后伸腕伸指功能的疗效。方法2010年1月至2010年6月，取雄性幼年（生后7d）和成年（大于3月龄）SD大鼠各24只。行C5－7，神经根切断后，将幼年和成年大鼠各随机分为3组：A组神经移植修复臂丛上、中干；B组神经移植修复上干，中干不予修复：C组上、中干不予修复。术后3个月行如下检测：①各组大鼠垂腕垂指发生率。②实验侧桡神经组织学检测。③前臂伸肌组织学检测。④Westernblot检测前臂伸肌组织内MyoDl及Myogenin的蛋白表达水平。结果①行为学检测：幼年和成年大鼠A组均无垂腕垂指；幼年B、C组大鼠垂腕垂指发生数分别为5和8例，高于对应成年组的0和3例（P〈0．05）。幼年A组垂腕垂指（0例）少于幼年B组（5例）（P〈0．05）和C组（8例）（P〈0．05），B、C两组间差异无统计学意义（P〉0．05）；成年大鼠A、B两组间垂腕垂指发生数均为0，均少于C组（3例）（P〈0．05）。②桡神经组织学检测：实验侧桡神经有髓神经纤维数量百分比依次减小（P〈0．05）；成年A、B两组间的差异无统计学意义（P〉0．05），但均高于C组（P〈0．05）。③前臂伸肌组织学检测：幼年A、B、C组指总伸肌肌细胞截面积恢复率依次降低（P〈0．05）；成年A、B两组问比较差异无统计学意义（P〉0．05），但均高于C组（P〈0．05）。④分子生物学检测：幼年A、B、C三组指总伸肌MyoDl和Myogenin与B—actin的吸光度比值均依次升高，两两比较的差异均有统计学意义（P〈0．05）。成年A、B组MyoDl和Myogenin与B—actin的吸光度比值的差异无统计学意义（P〉0．05），但均低于C组（P值均小于0．05）。结论臂丛C5－7根性损伤后，成年大鼠单纯修复上千和修复上、中干对伸腕伸指功能的疗效无明显差别；幼年大鼠单纯修复上干对伸腕伸�Objective To evaluate the influence of different surgical technique on the pup and adult rats after the rupture of upper trunk and middle trunk so as to find the best way of surgical therapy. Methods From January 2010 to June of 2010, forty-eight Sprague-Dawley male rats were divided into two groups of 24 each, i.e., pup groups at the age of 7 days postnatal （P7） and one adult （3 months old） group. After C5-7 injured, each group was subdivided into three equally： group A （repair Cs-7）, B（repair C5.6）, and C （no reinnervation performed）. In the 3rd month postoperatively, the following tests were performed to estimate the recovery of each group： （1）Compared the rate of carpoptosis of each group. （2）Compared the regenerated nerve traversing rate of the radial nerve in each group. （3）HE stain to compared the cross-sectional area recovery rate. （4）The MyoD1 and Myogenin of the affected extensor of forearm were measured by West- ern blot. Results （1） The ethology test： there were no carpoptosis in group of adult A and pup A; the earpoptosis rate of pup B and pup C were higher than that of adult A （P 〈 0.05） ; the carpoptosis rate of pup A was lower than that of B and C（P 〈 0.05）; there was no difference between earpoptosis rate of adult A and B ,but they were both lower than C（P 〈 0.05）. （2） Histological test of radial nerves： The percentage of myelinated both higher than C （P 〈 0.05）. （3） Western blot： The protein level of MyoD1 and Myogenin in radial nerve fiber in experimental side of pup A, B and C descended progressively （P 〈 0.05）. There was no difference between adult A and B, but they were both higher than C （P 〈 0.05）. （4） Histological test of the extensor digitorium： There was no difference between cross-sectional area recovery rate of adult A and B, but they were pup A, B and C increased progressively （P 〈 0.05）. There was no difference between protein level of MyoD1 and Myogenin in adult A and B, but th

关 键 词：产瘫 臂丛损伤 神经移植 重建 大鼠 

分 类 号：R651.3[医药卫生—外科学]